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Emergency Medicine: The Art of Jugglingby Dipali Pathak 
Dr. Greg Buehler, an emergency physician, stands outside the Ben Taub Emergency Center. In a teaching hospital such as Ben Taub General Hospital, juggling several tasks at one time is essential. In the emergency center, where seconds count, the task can be a matter of life and death. An emergency medicine physician's top priority is stabilizing the patient and reversing medical conditions or injuries before they cause permanent damage or threaten the patient's life. Ben Taub houses a Level 1 Trauma Center that sees an average of 300 cases per day ranging from gunshot wounds to high blood pressure. That puts special pressure on an emergency physician, particularly in an academic setting. Getting each patient through the emergency center safely and quickly is always first priority. Medical students, learning the ropes of patient care, rely on these physicians to guide them in the care they help provide. That education may one day mean that they too are charged with the task of saving lives. At the emergency center at Ben Taub Hospital, the art of juggling such tasks is all in a day's work. 
Dr. Shkelzen Hoxhaj Dr. Shkelzen Hoxhaj, interim chief of the section of emergency medicine at BCM, has taken the lead in transforming the system of emergency care at Ben Taub. When he arrived in October of 2007, the emergency center was set up in specialty silos. Surgical emergencies were seen in one center, pediatric emergencies in another and obstetrics and gynecology patients in another. The total came out to six different silos, and then the shock rooms, all run by physicians in different specialties. He has recruited 14 new faculty members in the past two years, paving the way for the establishment of the section of emergency medicine within the department of medicine in the fall of 2009. Hard work pays offToday, Ben Taub has one combined emergency center that operates on the emergency medicine model, providing most adult medical and critical care needs. The pediatric and psychiatric emergency centers remain separate, but work closely with the main emergency center. "The emergency medicine model provides more seamless care, efficient and higher quality of care so that you have someone who can manage all the different aspects of the problem. If a patient has a head injury, but he or she also has abdominal pain, those can be managed by one person as opposed to two different specialists," said Hoxhaj. "We've also brought in a lot more stateoftheart technology and therapies for the patients of Houston." "We want to make sure that optimal patient care is delivered to every patient who arrives at Ben Taub." Along with hiring board certified emergency medicine doctors, Hoxhaj and his team also added 12 midlevel providers, including physician assistants and nurse practitioners, who help the flow of the emergency room by starting some aspects of the patients' care before they see the physician. 
Dr. Angela Fisher Thus far, the results of the transformation are tremendously positive. Decreased wait timeIn January of 2009, the average time it took for a patient to be seen by a provider after arriving at the emergency center was four hours and fifteen minutes. In December of 2009, the number was down to 54 minutes, said Dr. Angela Fisher, assistant professor of medicine at BCM and medical director of operations at the Ben Taub emergency center. In January of 2009, an average of 13.8 percent of patients who checked into the emergency center would leave without being seen by a physician. In December 2009, that number decreased to only 3.6; on par with the best hospitals in Houston. "We want to make sure that optimal patient care is delivered to every patient who arrives at Ben Taub," said Fisher. "Emergency physicians do all things. We're resuscitation specialists; we stabilize you so that you can get to the definitive care needed." Once the emergency medicine physicians determine what the problem is, specialists at Ben Taub are waiting to take over. "Anybody who has a reversible, resuscitatable condition gets to that definitive care. When you're talking about quality of life—your ability to interact with your family and go to work—seconds count. The ability to intervene at the moment the condition is occurring and reverse that condition before permanent damage is done makes all the difference in the delivery of optimal healthcare," said Fisher. Improved atmosphereAlong with these changes, the emergency medicine group has pushed to improve the atmosphere in the center with the addition of artwork and other décor. Patient service liaisons help patients navigate through the emergency center. All of these things contribute to improving patient satisfaction, said Hoxhaj. Another priority of the new section of emergency medicine was to apply to the Accreditation Council for Graduate Medical Education for approval of an emergency medicine residency program. In March, the new program received a three-year accreditation, the longest such cycle issued for initial accreditation. The newly accredited program is a three-year training program and was approved to train as many as 12 residents per year. This year, eight students from across the country were accepted into the new program, and their training will begin in July 2010. Initially, the training will take place at Ben Taub and Texas Children's Hospital. Residency program benefits community"The residency program will bring a new level of emergency care for the Houston community," said Hoxhaj. "Currently, there is only one other emergency medicine residency program in Houston, and six in the entire state of Texas, so this new program is much needed." 
Dr. Bobby Kapur works at the Ben Taub Emergency Center desk. Dr. Bobby Kapur, assistant professor of medicine at BCM, will serve as the residency program director, overseeing the program and the training of the residents. He is also the director of educational affairs at Ben Taub. Baylor was one of two top 50 medical schools that did not have an emergency medicine training program. "It was the last core residency specialty that Baylor did not yet have. It completes Baylor's portfolio of core training programs," said Kapur. "We have high caliber students who've wanted to train in emergency medicine who have had to leave the state because there weren't enough options in the state, and when they leave the state, they don't come back. The state of Texas has a shortage of emergency physicians." By establishing a program at BCM, the hope is to keep highly trained emergency physicians in Houston and in the state of Texas. Physicians tend to remain near the regions in which they train, and Houston's growing community presents many local opportunities for emergency physicians. Safety net servicesEmergency centers serve as safety nets for the healthcare system, said Kapur. Those who get sick after hours or who do not have insurance rely on emergency centers for their care. "We need to train more emergency physicians because we need to have emergency physicians staffing and treating patients in our emergency departments," said Kapur. "These are our sickest and most critical patients, and they need to be evaluated and treated by physicians who are trained to treat, see, care for and manage sick and critical patients." Having emergency physicians care for patients who come to the emergency department has become the standard of care. "When you walk in the door, you want to be seen by an emergency medicine doctor," said Kapur. "Currently, there is only one other emergency medicine residency program in Houston, and six in the entire state of Texas, so this new program is much needed." For Roman Nieto, a 2010 graduate of BCM, staying in Houston for his residency in emergency medicine seemed unlikely at first. Then, when the program was approved, he realized that this is where he wanted and needed to be. Roman and his wife Crystal, who also graduated from BCM this year, welcomed their first child in June. Crystal's first choice for residency was in pediatrics at Texas Children's. They wanted to be close to family because of the new baby. "I quickly decided that the program was a perfect fit for me and would allow me to reach my full potential in the least amount of time. The strength of the administration and faculty will no doubt make this one of the top programs in the country in no time at all," said Nieto. "I'm excited to be a part of the inaugural class." |
FeaturesThe Future of Health Care Starts at Med High Emergency Medicine: The Art of Juggling A Quarter Century of Invention at Baylor College of Medicine "Passport" Gives Childhood Cancer Survivors Entry into Adult Healthcare Dan L. Duncan Cancer Center Educates Through Entertainment Getting to the Roots of Cancer NewsDr. Paul Klotman: BCM's New Top Man Dan Duncan Leaves Solid Foundation for BCM's Research Future DeBakey Library & Museum Showcases Innovations of Pioneering Heart Surgeon SpotlightBIPAI Doctor Seeks to Serve in Africa Space Medicine Takes Medical Education Across New Frontiers Quest for a Gene Opens New Door in Personalized Medicine BriefsOut of This World Science Experiment Generates International Interest Predicting the Progression of Alzheimer's Disease Pool to Receive Academic Clinical Professionalism Award The Pea Aphid and the Wasp Genome Development/AlumniBelieve in BCM Campaign Engages Campus Development BriefsNational Osteoporosis Foundation Honors Lawrences DeBakey Heart Center of BCM Benefits from Partnership Event Pink Ribbon House Project Celebrates Success Awards and Honor Wall Highlight Alumni Reunion 2010 The Road Ahead Promises Continued Success Pediatric Emergency Medicine
Dr. Joan Shook The section of emergency medicine within the department of pediatrics at BCM has been doing pediatric emergency medicine for nearly 20 years and works with students, residents and fellows who are interested in learning emergency medicine skills. It covers the emergency departments at Texas Children's and Ben Taub hospitals as well as the emergency departments of the Texas Children's Health Centers in the Woodlands and Sugar Land. It will also cover the emergency department at the new Texas Children's West Campus, scheduled to open in Spring 2011. The section covers emergency medicine, hospital medicine, observation medicine and child protection. Hospital medicine covers inpatients, and observation medicine covers patients who are in the hospital for 23 hours or less. Through the child protection service, physicians care for abused or possibly abused children. The emergency center at Texas Children's sees about 120,000 patients per year, and is working towards becoming a Level 1 Trauma Center, according to Dr. Joan Shook, head of the section of pediatric emergency medicine at BCM and Texas Children's. |
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Volume 6, Issue 1, Summer 2010 |
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